MEDICARE: GREAT HEIGHTS FAMILY MEDICINE LTD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207QA0401X	Addiction Medicine (Family Medicine) Physician	65528584	IL

General Provider Information

NPI Number	:	1285854067
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREAT HEIGHTS FAMILY MEDICINE LTD.

Provider Business Mailing Address
First Line	:	1473 RING RD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5459
Country	:	US
Telephone Number	:	312-952-9378
Fax Number	:	708-862-8105

Provider Business Practice Location Address
First Line	:	1473 RING RD
Second Line	:
City	:	CALUMET CITY
State	:	IL
Zip	:	60409-5459
Country	:	US
Telephone Number	:	312-952-9378
Fax Number	:	708-862-8105

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADEYEMI OLUDARE FATOKI
Credential	:	M.D.
Telephone Number	:	708-862-8156

Provider Enumeration Date	:	04/26/2007
Last Update Date	:	01/23/2017

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